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Barrett > Final > Flashcards

Final Flashcards

1
Q

centor critera

A 
Temperature >38c or 100.4F +1
Absence of Cough +1
Anterior Cervical LAD +1
Tonsil Swelling/Exudate +1
3-14 yo +1
15-44 yo +0
45+ yo -1
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2
Q

centor criteria <1

A

1-2% risk, no further testing or abx

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3
Q

centor 1

A

5-19% risk, no further testing or abx

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4
Q

centor 2

A

11-17% risk, culture or RADT, abx for positive culture only

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5
Q

centor 3

A

28-35% risk, culture or RADT, abx for positive culture only

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6
Q

centor >4

A

treat empirically with abx +/or culture/RADT

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7
Q

who to perform RADT on

A

patients with two or more centor
high risks hosts (HIV splenectomy, diabetes)
history of rheumatic fever

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8
Q

patients that RADT and culture in unnecessary

A

patient with classic signs and close contacts that have already tested positive
scarlet fever (sandpapery rash on trunk worse on groin and axilla)
strep epidemics
prior abx

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9
Q

who is strep unlikely in

A

0-1 centor
>25 yo
afebrile
no cervical LAD or posterior adenopathy

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10
Q

trismus

A

spasm of facial and jaw muscles, unable to open mouth fully

common w/ peritonsillar abscess/quincy

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11
Q

Peritonsillar abscess

A

gold standard dx and tx is needle aspiration
presents with unilateral enlarged tonsil w/ displaced uvulu
palpate for fluctuance = abscess

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12
Q

suppurative complications of pharyngitis

A

peritonsillar abscess (quinsy) & retropharyngeal abscess

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13
Q

ludwig’s angina

A

infx in submental space = lump under neck
mb fatal
presents as severe trismus, drooling and airway compromise, collar of brawny edema, elevation of tongue
refer if unresolved after tx, airway compromise, abscess present

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14
Q

ddx of chronic sore throat

A

infx
irritative czs: relfux pharyngitis, post-nasal drop, toxins, poor vocal cord hygiene, vocal abuse, chronic cough, vascular issues
neoplastic: nasopharyngeal, oropharyngeal, laryngeal, upper esophageal carcinomas, tumor under the sternum

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15
Q

globus

A

subjective sensation of lump or mass in throat unrelated to swallowing
Common Czs: Overeating, GERD or asx reflux, cervical osteophyte, thyroglossyl cyst, strictures, webs, neck malignancy

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16
Q

diphtheria

A

blue-white membrane adhered to posterior pharynx
cx by corynebacterium dip
neurotoxins may cause cardiac depression

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17
Q

Retropharyngeal Abscess

A

dyspnea, stridor, & hot potato voice

Anterior bulging in post pharynx, stiff neck w/high fever, usu 2⁰ to dental infx, foreign body or trauma

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18
Q

epiglottitis

A

m/c dt H. flu type B
Hx: Sore throat, ↑fever (> 102), weak/hot potato voice, drooling, sit upright - head forward/neck extended, Stridor
PE: Trismus, excess drooling, swollen uvula
Def Dx: by visualization; usu via lateral soft tissue x-ray Thumb print sign- epiglottis broadening & flattening

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19
Q

Croup

A

90% of time viral; RSV; usu infant -5 yo, m/c in fall and spring
Sx: Inspiratory stridor, Seal bark cough; paroxysmal cough
Starts as URI & low grade fever, cough turns barking on 2nd or 3rd day, worse at night; mb fine during day
Mb Steeple sign narrowing of subglottic airway on anteroir soft tissue x-ray

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20
Q

Croup tx

A

Homeopathic: Aconite Spongia Hepar; Drosera: cough cough cough then heave
Warm shower; Cool damp air or humidifier
Echatin plus (NF) - Echinacea, Lingustrum, Schizandra
Compound liniment Stillingia - nasty tasting; use with Tbs of honey; can also use topically
Hospitalization needed if: sx of hypoxia, tachypnea, stridor, tachycardia, paroxysmal cough

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21
Q

hx in pt with sleep apnea

A

overweight, daytime fatigue, snore loudly

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22
Q

morbidity of sleep apnea

A

increase >20 apnea events/hour

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23
Q

dx sleep apnea

A

sleep study, >19 apnea/hypopnea events/hour

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24
Q

sleep apnea tx

A

good sleep, abstain from alcohol and sedatives, wt loss and avoiding supine position during sleep, CPAP, oral appliances, surgical reduction of soft palate tissue, didgeridoo playing

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25
Q

bordetella pertussis spread

A

most infectious during 1st phase-catarrhal, spread via airborne droplets

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26
Q

3 phases of pertussis

A

Catarrhal phase: 1-2 wks, resembles a viral UVI, most contagious in this phase
Paroxysmal phase: 1-6 wks of paroxysms of coughing w/characteristic “whoop”, post-tussive emesis & cyanosis.
Convalescent phase: paroxysms gradually improve over 2-12 weeks

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27
Q

Pertussis vaccine immunity

A

Immunity from vaccinations is short-lived & incomplete. Immunity declines after 4-12yrs

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28
Q

Complications assoc w/severe cases of Pertussis:

A

pneumonia, dehydration, wt loss, sleep disturbance, seizures, cerebral hypoxia, refractory pulm HTN, encephalopathy or death

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29
Q

Age group most at risk for complications (of pertussis)

A

infants

30
Q

greatest sensitivity for detecting pertussis

A

PCR assay

31
Q

specimen collection for pertussis

A

polyester swab of nasopharynx – insert into base of a nostril & leave in posterior pharynx for 10 sec

32
Q

is pertussis reportable

A

yes, to county health dept

33
Q

CDC definition for pertussis

A

Cough lasting >2 wks develops paroxysmal quality, inspiratory whooping, or post-tussive emesis; & in infants with severe cough, apnea, or bradycardia for any length of time.

34
Q

amblyopia

A

lazy eye, neuro signal weak/unused in one eye; Best Dx as child ASAP to correct w/eye patch

35
Q

management of eye trauma

A

DON’T PRESS ON THE EYE may lead to extrusion of vitreous humor into the cheek
Hx: Ask about pain, blurred vision, photophobia, double vision, were safety glasses worn?

36
Q

visual change of more than 1 line on snellen chart suggests

A

corneal abrasion, retinal detachment, and lens dislocation
Refer to ophthalmologist if: Diminished vision, disturbed or asymmetric pupils (> 20% difference), evidence of retinal damage on funduscopic exam or Ocular misalignment (diplopia), Hyphema-can precipitate acute glaucoma

37
Q

treatment for eye trauma

A

Tx: Ice the 1st day, heat 2nd & 3rd
Bromelain, plant enzymes
Homeopathy: Aconite- abrasions to the eye
Symphytum - specific for blunt trauma to the eye & orbit
Arnica - for injuries to orbit, with typical arnica picture, thinks they are fine

38
Q

aconite for

A

abrasions to the eye

39
Q

symphytum for

A

blunt trauma to the eye and orbit

40
Q

arnica for

A

injuries to orbit, typical arnica picture, thinks they are fine

41
Q

SUBCONJUNCTIVAL HEMORRHAGE

A

Spontaneous appearing patch of hemorrhage over sclera, painless; normal vision
Increased incidence in pts with HTN or bleeding d/o, usu follow minor trauma, coughing or sneezing

42
Q

painful red eyes usually associated w/

A

cornea and iris which are the most innervated structures in outer eye

43
Q

if eye is painful but not red

A

consider referred pain from sinuses, orbit, nose

44
Q

red eye w/ impaired vision

A

Allergic; Acute glaucoma - refer immediately; Iritis; Corneal dz

45
Q

always ask patient with red eye

A

if they have impaired vision

46
Q

hyperacute red eye

A

gonococcal conjunctivitis

47
Q

subacute red eye (1-3 days)

A

usually conjunctivitis especially if d/c

48
Q

chronic red eye

A

Chronic Staph Blepharitis, Chlamydia infx, Moraxella bacteria

49
Q

recurrent red eye

A

Allergic conjunctivitis, Recurrent Iritis - Reiter’s syndrome

50
Q

red eye w/ photophobia

A

Iritis, uveitis, Corneal dz, Acute angle closure glaucoma

51
Q

hx of iritis

A

significant pain, impaired vision, photophobia

52
Q

key pe of iritis

A

pupil is poorly reactive to light

53
Q

how to visualize corneal abrasions

A

fluorescein dye and use cobalt blue light

54
Q

tx for bacterial conjunctivitis

A

Good hygiene: Wash hands thoroughly, use kleenex to remove d/c
Eye irrigation: Botanical formulas or normal saline wash medial to lateral, to avoid infx of lachrymal apparatus
Botanicals: Berberis , Euphrasia, Hydrastis, Hamamelis, Fennel & Calendula
Cool compresses, treat any underlying imbalances/allergies
Abx: Z-pack if Chlamydia

55
Q

External Hordeolum (Sty):

A

localized infx on external margin of lid; painful red on lower lid; more painful; usu dt S. aureus

56
Q

Internal Hordeolum (Chalazion):

A

sterile inflmtn of meibomian glands; usu painless; tend to be chronic

57
Q

Blepharitis

A

inflmtn around margins of lid; usu dt chronic Staph infxs, common w/seborrhea or rosacea

58
Q

Dacryocystitis:

A

swelling & redness of lacrimal sac(btn canthus & bridge of nose) pressing on sac czs mucopurulent d/c;
excess tears overflow

59
Q

Cataract Hx

A

Gradual loss of vision, hard to drive at night

60
Q

Cataract PE

A

Red reflex decreased or absent

If you can see in, then the patient can see out = unlikely that cataracts are the cause of the visual problem

61
Q

cataract risk factors

A

Ocular dz, injury, surgery, DM, Galactosemia, UV light, Smoking, Genetics

62
Q

cataract tx

A

Avoid sunlight (free radicals); sunglasses w/ 100% UV block
Supplements: Flavonoids, Omega 3 FAs; β-carotene; Vit C, Vit E, Se, Quercitin, NAC, α-lipoic acid, Cr -if dysglycemic
Botanicals: Chaparral, Cineraria maritime (lymphagogue), Vaccinium- bilberry, Ginkgo biloba, Ginger & Curcumen inhibit aldose reductase diabetic cataracts
N-acetylcarnosine eye drops

63
Q

angle closure glaucoma

A

Angle Closure Glaucoma: red eye, n/v & diminished vision. Sx mb after exposure to a dark environment; perilimbal injx, cloudy cornea, narrow anterior angle => iris shadow, & pupil fixed & dilated
***Ocular emergency that requires emergency ophthalmologic assessment to prevent blindness
RFs: hyperopia (far vision)

64
Q

primary open-angle glaucoma RF and pathogenesis

A

RFs: Age, Af. Am., ↑IOP, myopia, DB, systemic HTN, ↑EtOH intake (whites), hypothyroid & FHx of glaucoma
Pathogenesis: 3 primary theories:
1) Mechanical: aqueous humor produced by ciliary body doesn’t drain adequately thru trabecular mesh-work ↑ IOP
2) Vascular mechanism – dt HTN – poor optic n. perfusion & loss of retinal ganglion cells from apoptosis
3) Glutamate toxicity: glutathione deficiencies from oxidative stress lead to ↑introcular levels of glutamate (neurotoxin)

65
Q

primary open angle glaucoma dx

A

loss of peripheral vision can progress to loss of central vision, loss of peripheral fields by confrontation, ↑cup:disc ratio, ↑IOP , iris shadow

66
Q

primary open angle glaucoma tx

A
  • For IOP: beta blockers (timolol, betaxololo), cholinergeic agents (pilocarpine); drugs ↓aq. secretion
  • Lazer or conventional surgery to enlarge the canal of Schlemm (trabeculectomy)
  • Avoid vasoconstrictors, i.e. caffeine, nicotine; Avoid excess fluid intake
  • Stress mgmt.
  • High dose Vit C, bioflavonoids, Bilberry, Gingko biloba, Cannabis
  • Botanical eye drops: Forskolin, Foeniculum vulgare
  • Antioxidant combinations, Vit C, E, Se, glutathione, beta- carotene
  • Alpha Lipoic acid, Mg, Vit B12
  • Manipulation & Acupuncture
67
Q

Signs & sx of Acute angle closure

A

severe ocular pain & redness, decreased vision, h/a, n/v, conjunctival injx, hazy cornea, dilated pupil, ant chamber inflmtn, can have permanent vision loss

68
Q

Signs & sx of keratitis

A

Scattered, fine, punctate loss or damage of epithelium from corneal surface
Sx: photophobia, FB sensation, tearing, conjunctival hyperemia, ↓visual acuity, mb enlarged preauricular nodes in viral conjunctivitis
Keratitis dt UV light exposure does not appear until several hrs after exposure; it lasts 24 - 48 hrs.
Permanent vision loss is rare, regardless of cause

69
Q

Tx for MACULAR DEGENERATION:

A

Progressive visual loss due to degeneration of the macula lutea.
Control atherosclerosis, smoking cessation (oxidative damage)
Supplements: trace elements, antioxidants, and vit C, E, Beta carotene, Zn, Cu, Taurine, Omega 3 FAs
Ozone therapy
Increase physical fitness, improve nutrition, protect from excessive UV light exposure
Diets high in dark leafy green and spinach are high in carotenoids
Vaccinium, Ginkgo biloba , Lutein and Zeaxanthin
IV Therapy: Zinc, Se, Glutathione

70
Q

Dry Macular Degeneration

A

atrophic – irreg macular pigmentation, no macular scar or hemorrhages or exudate
80-95% of cases
Signs/Sx: painless GRADUAL loss of central vision in one or both eyes difficulty reading or driving, scotomas, or increased reliance on bright light or magnifying lens; Onset is slow and peripheral vision remains intact
PE: Drusen bodies – plaque like deposits (seen in both wet & dry AMD)

71
Q

Wet Macular Degeneration

A

Abnormal BVs form to improve blood supply to oxygen-deprived retinal tissue
~ 10% of macular degeneration patients have wet AMD
Signs/Sx: New vessels break easily bleed & damage surrounding tissue ACUTE Vision loss (over days or wks) requires urgent ophthalmic evaluation. May look like flame hemorrhages or pooling of blood
Tx: IV injection of anti-VEGF (Vascular endothelial growth factor) monoclonal Abs is a very promising tx

Barrett (1 decks)

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